Despite a lot of posturing and complaining, the Republican opponents of the Affordable Care Act (ACA) are relatively limited in what they can do to prevent implementation of Obamacare. Sadly, however, there is one aspect of the law that Republicans at the state level have demonstrated that they’re eager to fight back against, and—no big surprise—it’s the one that affects some of the most financially needy Americans: Medicaid expansion. The Supreme Court ruled last year that the provision—which would require states to expand Medicaid to cover people up to 133 percent of the poverty line—is optional, and so far 21 states have decided to opt out.

The result, according to ThinkProgress’ Sy Mukherjee, will be devastating. Mukherjee reports on a new study by the Commonwealth Fund, which shows that these Medicaid expansion refusals could result in up to 42 percent of the people living in those states who went uninsured at some point in the past two years being left out of Obamacare. As the unemployment rate continues to hover above 7 percent, the chance that this giant hole in coverage will somehow resolve itself through employment for the poorest Americans seems like a long-off fantasy.

Make no mistake: The only reason Republican-led states are doing this is out of an ideological distrust often bordering on hatred of the working class. According to the relentless drumbeat of conservative media outlets like Fox News, people who require government help to survive are just lazy leeches who think they’re too good to fight for a better-paying job. But the second that the lowest-income Americans do stand up for themselves and demand better pay so that they don’t have to go on Medicaid and food stamps, the very same conservatives angrily denounce them for that too. You’re a bad person if you need help. You’re a bad person if you seek a job with a living wage. Given the conservative mentality, there’s nothing people can do to win.

The refusal to accept the Medicaid expansion cannot be justified through the usual half-baked conservatives rationalizations. It doesn’t save the states any money to refuse it; the expansion is to be paid for almost entirely by the federal government. In other words, taxpayers in those states will pay the same taxes as everyone else, but their states will get less in return. That means it is costing the states money to refuse the Medicaid expansion. And that’s all before the excessive health costs that end up falling on taxpayers when people who don’t have insurance end up in emergency rooms, often because they couldn’t afford preventive care. In addition, refusing the Medicaid expansion reduces the amount of competition on the insurance market, meaning that even well-off Americans in red states will be paying more for insurance.

In other words, given a choice between saving their states and their taxpayers money and deliberately forcing lower-income Americans to go without health care, most Republican state governments have chosen the latter. (Though not all—Arizona, New Jersey, Iowa, and North Dakota all have Republican governors who decided they want a better-run state more than they want to stick it to the poor.)

Women are going to be badly affected by this petulant screw-the-poor grandstanding on the part of Republican state legislators and governors. This January, the American College of Obstetricians and Gynecologists issued a press release pointing out that 19 million women are uninsured and that the Medicaid expansion could change that. Because of the holes in insurance coverage in the current system, there’s a much higher incidence of bad outcomes with sexual and reproductive health than there should be. Some direct statistics quoted from the press release:

Uninsured pregnant women receive fewer prenatal care services than insured women and are more likely to experience adverse maternal outcomes such as pregnancy-related hypertension and placental abruption. Adverse outcomes, such as low birth weight and infant mortality, also are more common among uninsured women. Improved maternal and fetal outcomes occur with access to high-risk pregnancy care, counseling, and other enabling services. … Inadequately addressing pregnancy complications may have disastrous long-term emotional and economic effects on families. Society may face unintended increased costs to provide medical services to care for children born to uninsured women who have pregnancy complications.

Uninsured women are less likely than insured women to use prescription contraceptives, partly accounting for adverse reproductive health outcomes, including elevated rates of unintended pregnancy and abortion in poor women …

Uninsured women with breast cancer are 30–50% more likely to die from cancer or cancer complications than insured women with breast cancer …

Uninsured women are 60% more likely than insured women to receive a diagnosis of late-stage cervical cancer.

One of the ACA’s great benefits to women of reproductive age is access to birth control without a co-pay. While contraceptive use was already improving in the population writ large—particularly among teens—lower-income women still have serious problems preventing unintended pregnancies, in no small part because paying out-of-pocket for contraception is often out of reach. Pills sometimes have to be skipped because you can’t afford them this month, and while condoms may seem cheap to middle-class Americans, a box of them at the drugstore costs as much as what is supposed to be three days worth of food on food stamps. When you’re living so close to the edge, being able to scrounge up enough for contraception is a touch-and-go thing, which is no doubt why unintended pregnancy rates are going up for lower-income women even as they go down for everyone else.

With one swift, cost-effective move beneficial to both taxpayers and public health alike—embracing the Medicaid expansion—Republican governors can help close the health-care gap between low-income Americans and everyone else, a gap that currently contributes to more unwanted pregnancies and more abortions. They must stop posturing to win the accolades of right-wing media who enjoy the idea of starving out the poor for the simple sadistic pleasure of doing so.

In May, lawmakers in Indiana passed a bill that prevents Medicaid from contracting with any entity that provides abortions. The bill essentially stripped millions of dollars in funding from Planned Parenthood in knowing violation of the Medicaid rules and placed the state among others in a conservative crusade to kill off the women’s health care provider.

According to those rules, states largely get to design their own programs for providing health insurance coverage for low-income people, but they cannot ban providers from participating in the program solely on the basis of the range of medical services they provide — especially family planning services. Federal law already prohibits the use of any federal funds, including Medicaid funding, from providing for abortions, so this would seem to be a settled issue. Furthermore, US Senator Richard Blumenthal (D-CT) and twenty-nine other Senate Democrats issued a letter to Health and Human Services (HHS) Secretary Kathleen Sebelius requesting that HHS officials advise Medicaid directors not to implement measures to prevent Medicaid or Title X funding from going to clinics that offer abortion services, making it clear that Democrats had the administration’s back in a fight over funding. HHS rejected the Indiana law.

Prior to NFIB v. Sebelius, the idea of an outright challenge to the federal strings attached to Medicaid spending seemed preposterous, just like prior to NFIB v. Sebelius the idea that Congress didn’t have the ability to tax and spend to regulate the health insurance industry wasn’t treated with any seriousness by a majority of legal scholars.

Oh what a difference one opinion can make.

Thanks to the majority in NFIB v. Sebelius, conservative states looking to enact state-wide funding bans may have the framing necessary to pin the federal government. That’s because the language of Roberts’ opinion as to the Medicaid expansion is vague enough to argue that the federal government can’t coerce a state into funding Planned Parenthood by threatening to withhold all of that state’s federal Medicaid money, especially, since conservative states argue, they believe cutting Medicaid funds is the only way to guarantee state dollars do not fund abortion services.

Now, to be clear, Roberts takes great pains in his opinion on the Medicaid expansion to ground the outcome in the particular facts of the expansion under the ACA and the two-fold carrot-and-stick approach to getting states to expand their Medicaid coverage for low income Americans. But, much like the Supreme Court’s decision upholding the federal partial birth abortion ban in Carhart v. Gonzalez, such precision can actually create more room for legal challenges than less. Roberts’ opinion doesn’t delineate the contours of when the federal government is and is not being unconstitutionally coercive to the states in a conditional grant situation.

That means the lower courts will get to parse those boundaries out while fighting over how far, or if at all, they can challenge federal rules that prohibit them from discriminating against the health care provider. And it’s a good reminder that while the immediate victory in the Affordable Care Act was certainly something to celebrate, as the details of the decision play out women’s health advocates could find themselves stuck with some very bad law.

]]>http://rhrealitycheck.org/article/2012/07/16/battle-over-planned-parenthood-funding-in-indiana-may-be-first-test-coercion-theo/feed/0Questions for Paul Ryan, Mitt Romney and Other Opponents of Health Care Reform: Where Are Your Facts?http://rhrealitycheck.org/article/2012/07/02/questions-health-care-reform-opponents/?utm_source=rss&utm_medium=rss&utm_campaign=questions-health-care-reform-opponents
http://rhrealitycheck.org/article/2012/07/02/questions-health-care-reform-opponents/#commentsMon, 02 Jul 2012 08:00:44 +0000Many of the objections to the Affordable Care Act after the Supreme Court decision make no sense if you know what's actually in the bill. Without more explanations, it's hard to avoid feeling like opponents are just making stuff up.

]]>The Supreme Court ruling on the Affordable Care Act (ACA) on Thursday has caused a rush of panic from the opponents of universal health care. Lots and lots of claims about what the law does are being tossed around, and many of these claims are what you might call puzzling to those of us who actually know what’s in the ACA. Now, I don’t want to accuse anyone of intentionally lying without gathering more evidence, but without a deeper understanding of what various conservatives mean by their claims, it’s hard to suppress the sense that they may perhaps just be lying. So, I’ve made a list of questions I want opponents of health care reform to answer so I can better understand how their seemingly outrageous claims about the ACA make sense outside of the most obvious “lying” angle.

How does one “go on” Obamacare? Paul Ryan, denouncing the bill: “Millions of people who are otherwise going to go on Medicaid, are now going to go on Obamacare which costs a whole lot more money.” What is this “Obamacare” that people can go onto? I looked around to see if I could get an insurance plan through the “Obamacare” that Ryan and other conservatives are talking about Americans going on to and all I can find are the same old private insurance companies that existed before. The way Ryan & Co. talk about “Obamacare,” it sounds an awful lot like they think there’s a public option people can buy if they don’t want private insurance and aren’t eligible for Medicaid. But those of us who recall the big political fight over the ACA can tell you that there was originally a public option in the bill, but it was removed in order to get more votes from conservative Democrats. So what is this “Obamacare” conservatives keep insisting you can buy into and where do I find it?

How does the ACA remove your choice or get between you and your doctor? Various claims are being tossed around about health care reform “getting between you and your doctor” or taking away people’s choices in what medical treatments to pursue. In his remarks after the ACA ruling, Romney repeated this claim by saying the government is getting “more and more intrusive in your life” and “separating you and your doctor.”

So my question is: How? What medical decisions will the government now be making for you under the ACA? (Obviously, under conservative-supported legislation, the government has a lot of power to make decisions for women seeking abortion or contraception, but those laws aren’t part of ACA.) If you’re referring to the fact that insurance companies will retain the right to deny coverage for certain procedures they deem unnecessary, well, insurance companies already do that. If anything, the ACA has limited the ability of insurance companies to deny you the ability to pursue medical treatments you and your doctor choose, because the ACA has removed spending limits and banned insurance companies from denying you coverage based on pre-existing conditions.

How is the ACA going to force you to pay for abortion?A typical example of this claim from CNS News, saying the ACA requires that “Americans buy health insurance plans that pay for contraceptives and abortion.” The problem is that the executive order Obama tied to the ACA actually does the opposite on abortion, and requires that every state exchange have insurance options that don’t cover abortion, for those who actually consider that a priority, aka almost no one. If people making this claim are referring to the insurance plans they already have through their employers which often cover abortion, again, that’s a pre-ACA reality that didn’t seem to bother conservatives until they could use it to raise the public’s ire over health care reform.

Where are the parts of the bill requiring “rationing”? There’s no such requirement in the ACA. If people making this claim are referring to the insurance company practice of denying certain coverage they deem too expensive or medically unnecessary, I refer you to the above passage that points out that this was the policy before the ACA, and the ACA has restricted the right of insurance companies to deny coverage.

How is everyone in the country going to pay more in taxes?Paul Ryan and the folks at Fox News were making this claim, that this is a tax that will “hit everyone.” How will “everyone” be hit with this tax penalty? The bill couldn’t be more clear that you don’t pay this penalty if you have insurance. The majority of Americans actually have insurance, and more will buy it under this plan, with the hope being that eventually all Americans will have it. So if the majority are already not in a position of having to pay this and even more people will not be paying this, how does this hit “everyone?” Are conservatives stretching the definition of “paying” a tax to include taxes that you don’t pay, but maybe could have in an alternate reality where no one has health insurance?

What’s the game plan for the “replace” part of “repeal and replace”? In his remarks about the ruling, Romney claimed he wanted to “repeal and replace” the ACA with a bunch of provisions Jon Stewart pointed out are, uh, actually in the ACA. I have no problem believing that Romney, if he were President with Republican majorities in both houses of Congress, would be able to repeal the ACA. But replace it with what amounts to a nearly-identical bill? The first bill was barely able to pass with Democratic majorities in both houses. How would he get a nearly-identical bill past congressmen who have been clear from the get-go that they hate the very idea of health care reform? Why does he think that “repeal and replace” makes more sense than simply passing bills modifying the original legislation to take out the parts he doesn’t like as much, but leaving the parts—i.e., most of the bill—he claims to like intact?

These are but a few of many important questions I need opponents of the ACA to answer in depth to believe that they’re arguing in good faith. Because right now, it seems instead what’s going on is that opponents just hate health care reform, period, and are coming up with a lot of dishonest rhetorical dodges because they know the public at large wants a better health care system than we have now.

]]>http://rhrealitycheck.org/article/2012/07/02/questions-health-care-reform-opponents/feed/2Score One for Women’s Health! Obama Administration Stands Up For Birth Controlhttp://rhrealitycheck.org/article/2012/01/21/score-one-women%E2%80%99s-health-obama-administration-stands-up-birth-control/?utm_source=rss&utm_medium=rss&utm_campaign=score-one-women%25E2%2580%2599s-health-obama-administration-stands-up-birth-control
http://rhrealitycheck.org/article/2012/01/21/score-one-women%E2%80%99s-health-obama-administration-stands-up-birth-control/#commentsSat, 21 Jan 2012 09:41:39 +0000Today, the Obama administration stood up for women's health and announced it would keep in place a proposed rule that ensures that new insurance plans include coverage of contraception.

Most people may be keeping track of the NFL playoffs at the moment, but the big win today went to women. For anyone who’s keeping score, its women’s health — 1, discrimination — 0, with the Obama administration and thousands of women’s health proponents who pressured the Administration to do the right thing tied for MVP.

Today, the Obama administration announced that it would keep in place a proposed rule that ensures that new insurance plans include coverage of contraception, and provides an exception for houses of worship. The powerful U.S. Conference of Catholic Bishops’ lobby, among others, had pressed for months to create gaping loopholes so that a broad range of employers could discriminate against women and deny them coverage for this essential preventive care. They tried to do so in the name of “religious liberty,” but what we know, is that as a nation, we protect religious beliefs, but one person’s religion must not be used to trump another’s civil rights protections. Because of the outcry from groups like the ACLU, however, the Obama administration stood up for women’s health and did not broaden the religious exception. The final rule will give certain religious employers that do not currently cover contraception an additional year to come into compliance.

We also know that the majority of women of childbearing age, regardless of religious background, use some form of birth control for 30 years, at costs that range from $50 per month for oral contraception, to up to $1,000 for longer-acting methods. We use birth control to prevent unintended pregnancies, protect our health, and to plan our lives. That’s why the nonpartisan Institute of Medicine initially recommended to HHS that insurance companies be required to cover contraceptives in the first place, and why the administration adopted — and has now confirmed — that policy.

With today’s decision, good sense won out over political gamesmanship. And true religious liberty — which gives everyone the right to make personal decisions, including whether and when to use birth control based on their own beliefs — prevailed over discrimination.

]]>http://rhrealitycheck.org/article/2012/01/21/score-one-women%E2%80%99s-health-obama-administration-stands-up-birth-control/feed/2On Contraceptive Coverage, It’s Not Up to Obama to Decide What is More “Catholic”http://rhrealitycheck.org/article/2011/11/25/on-contraceptive-coverage-its-not-up-to-the-obama-administration-to-decide-what-is-more-catholic/?utm_source=rss&utm_medium=rss&utm_campaign=on-contraceptive-coverage-its-not-up-to-the-obama-administration-to-decide-what-is-more-catholic
http://rhrealitycheck.org/article/2011/11/25/on-contraceptive-coverage-its-not-up-to-the-obama-administration-to-decide-what-is-more-catholic/#commentsFri, 25 Nov 2011 11:29:34 +0000

The President seems unaware of the fact that Catholics who matter have disagreed with the Vatican’s current prohibition on contraception. Catholics, including institutions within the Catholic community, are free to follow their conscience on contraception. It is not up to the Obama administration to decide what action is more “Catholic" on the matter of contraception.

This article was amended at 2:22 pm Friday, November 25th to add a missing paragraph and missing words in three sentences.

When it comes to contraception, Catholics have stopped listening to popes, bishops and other institutional leaders. It seems the only person left listening is President Obama. Obama, however, lacks the theological training—and it would seem the scholarly advice—needed to figure out if the bishops and various hospitals, universities, and social service agencies clamoring for a broadened “religious exemption” from new federal regulations really need them in order to be good Catholics. The regulations require insurance plans offered by employers to cover contraception without a co-pay, although they exempt churches and other specifically religious institutions from the requirement. The United States Conference of Catholic Bishops and other groups have been lobbying for a much broader exemption.

The President seems unaware of the fact that Catholic disagreement with the ban on birth control goes far beyond the average Catholic layperson. Some bishops, many priests, religious orders, theologians and church-related groups have publicly and privately disagreed with blanket prohibition of contraception. All of them, individuals and institutions, are free to follow their conscience on contraception and there is ample evidence that many of the very groups asking for an exemption from the new federal regulations have not followed church regulations religiously. Some within the organizations may agree with the ban, but not all, and none are required to do so.

Of course, it would take courage for organizations such as the Catholic Health Association (which sent a letter to the Department of Health and Human Services in September supporting a broader exemption) or Catholic Charities to publicly buck the U.S. bishops, just follow the law and give their employees health insurance that makes it more possible to avoid pregnancies they cannot afford or do not want; but after all, being a Catholic is all about courage and helping the poor and marginalized. A fair number of employees of Catholic institutions are low-income workers, struggling to get by on a minimum wage. We Catholics are taught to follow our conscience rather than the positions of the Catholic church, even if it means getting kicked out of the church. If Obama’s current religious advisers don’t know that, all he has to do is call one of the most trusted of Catholic theologians, Fr. Richard McBrien of Notre Dame. McBrien will repeat what he has said in his widely used text Catholicism:

If, after appropriate study, reflection and prayer, a person is convinced that his or her conscience is correct, in spite of a conflict with the moral teachings of the church, they not only may but must follow the dictates of their conscience rather than the teachings of the church.

Centuries earlier Thomas Aquinas said the same thing. Yet, the Catholic-affiliated institutions asking for a religious exemption insist that corporations, like persons, have a conscience.

There is every indication that the conscience of these institutions tells them the church prohibition on contraception is wrong. Survey data and the behavior of these institutions evidence widespread disagreement with the official, but not infallible prohibition. Modest due diligence on the part of the administration before it grants a broader exemption is called for. They would discover that it is not only ordinary Catholics who believe birth control results in responsible parenthood and healthier relationships (98 percent of sexually-active Catholic women have used methods of birth control prohibited by the Vatican), but also bishops conferences, priests and theologians worldwide. The administration would also find numerous examples of “Catholic” agencies that have disregarded the prohibition and are providing or have provided contraception, including contraceptive sterilization.

That foundation of dissent from the 1968 Encyclical “Humanae Vitae,” which dashed Catholic hope of a new openness on sex and reproduction, was found in the statement of the Vatican spokesperson, Msgr.F. Lambruschini who assured reporters that it as not infallible a statement not contradicted by the Vatican. He then disturbed many of the world’s bishops by claiming the encyclical required “the assent of the faithful.”

That demand for assent to a non-infallible teaching opened a floodgate of commentary by Bishops’ Conferences around the world, hedging their bets on the encyclical and expressing sympathy with Catholics who decided not to follow it. The Canadian bishops wrote:

In accordance with the accepted principles of moral theology… persons who have tried sincerely but without success to pursue a line of conduct in keeping with the given directives, may be safely assured that whoever honestly chooses that course which seems right to him does so in good conscience.

The Dutch bishops were more forthright. All nine met and issued a statement that said they “consider that the encyclical’s total rejection of contraceptive methods is not convincing on the basis of the arguments put forward.” If the Dutch bishops did not find the Catholic prohibition on birth control convincing who is the President to de facto affirm a Catholic doctrine by providing some Catholics with an exemption from public policy mandates supported by popular, scientific and medical opinion?

The granting of an exemption from regulations that are in the best interest of public health and enhance the lives especially of women should never be a political act, but rather a careful, factual appraisal of an urgent and clear religious claim.

Many Catholic religious leaders have conducted that appraisal and found Humanae Vitae wanting. French, German, British, Belgian, and other bishops, while cautious not to openly challenge the teaching itself, issued statements that stressed the right of Catholics to follow their conscience. U.S. bishops, as always eager to demonstrate their loyalty to Rome, towed the line. American priests and theologians were far less constrained. Some theologians and priests immediately issued a Statement of Conscience that rejected Humanae Vitae. The authors felt so strongly that they published the statement in the Washington Post, leading D.C. Cardinal Patrick O’Boyle to punish about 40 of its signers who reported to him. The courage shown by those theologians and priests would be welcome among the leaders of today’s high-powered Catholic charities.

Among the signers was a revered DC Jesuit, Horace McKenna. Fr. McKenna was a passionate advocate of the poor who eventually founded D.C.’s SOME (So Others Might Eat). Based on his experience of hearing the confessions of DC’s poorest Catholics, he made it clear to Cardinal O’Boyle that he would tell them in confession that they were not bound to follow the prohibition. In short order, the Cardinal stripped him the right of hearing confessions.

In order to avoid punishment and conflict, most dissent on contraception by Catholic agencies is quiet. Catholic social services agencies treating migrant workers have had contracts with Planned Parenthood to provide contraception for their clients; Catholic hospitals allow doctors who have offices on their premises to prescribe birth control, some mergers between Catholic and non-Catholic hospitals accommodate family planning – and historically even found a way to provide contraceptive sterilization. Some deals fly under the radar and survive; others are squashed.

The bishops and cardinals have not changed. Unfortunately, there are few Horace McKennas left who will stand up for the poor against the tired efforts of bishops to demand public policy that conforms to their narrow view of what it means to be Catholic. If Horace McKenna were president of Catholic University or ran Catholic Charities instead of Larry Snyder, he’d be lobbying the bishops to provide birth control for poor women and migrant workers rather than fighting for the right to deny janitors, college students and healthcare aides insurance for contraception. He certainly would not be supporting the bishops, who, in the face of an Amnesty International report on the immorally-high rate of maternal death in the United States and the increasing poverty of women and children coldly claimed that pregnancy was not a disease and contraception not preventive medicine.

Today’s bishops are a cold-hearted, power-hungry lot. Not a Raymond Hunthausen among them. In 1986, Archbishop Raymond Hunthausen of Seattle was charged by the Vatican with allowing sterilizations to be provided in the diocese’s hospitals–-as well as lack of firmness on altar girls and gays. He was, for a time, denied the right to run his diocese; Bishops Donald Wuerl was appointed as “co-adjutor” of the diocese to ensure orthodoxy. Wuerl has risen to the rank of Cardinal and now presides over one of the poorest of the dioceses, Washington D.C. In the church today, only orthodoxy is rewarded.

The heavy hand of the Vatican also came down on the Sisters of Mercy. In 1980 after a five-year study, the Sisters, who then ran one of the largest hospital systems in the United States (only the Veterans Administration was larger) , decided that good medical care included providing postpartum contraceptive sterilization when women requested it. To deny them would subject the women to a second medical risk if they were sterilized at a later date. The Vatican got wind of the possible change in policy and threatened to put the whole community in “receivership” and take over their hospitals, schools, and everything else if they did not change their mind and prohibit sterilization. The Sisters capitulated, fearing greater harm to their patients if the Vatican were in charge.

Can the Obama administration decide which action was more “Catholic,” the Vatican’s power grab, or the sisters desire to provide women with the safest medical care? Can or should the state get itself in a position of closely scrutinizing the validity of religious and moral claims for an exemption from public policy decisions? We have just such a process in place for deciding whether a request to be exempt from military service: The state decides on a case-by-case basis if the claim is genuine or motivated by fear, laziness, or other less-than-honorable reasons. If we are to grant broad exemptions to religious institutions, should not a similar process be used?

Best Obama stay out of the internal theological disagreements Catholics have about reproductive health. Best he focus on implementing the long-standing policy consensus that family planning is essential to women’s health and empowerment and contributes to the social and economic wellbeing of all. The religious exemption the HHS has drafted which exempts organizations that have the inculcation of religion as their primary purpose and which employ and serve primarily members of their own faith respects unambiguous religious institutions. Combined with the conscience protection offered to individuals it is more than adequate protection of religious liberty.

These groups are asking you to join them in telling the White House not to capitulate to the United States Conference of Catholic Bishops and throw women under the bus on contraceptive coverage:

]]>http://rhrealitycheck.org/article/2011/11/25/on-contraceptive-coverage-its-not-up-to-the-obama-administration-to-decide-what-is-more-catholic/feed/13The Other 99 Percent: Will Obama Betray Them?http://rhrealitycheck.org/article/2011/11/20/the-other-99-will-obama-betray-them/?utm_source=rss&utm_medium=rss&utm_campaign=the-other-99-will-obama-betray-them
http://rhrealitycheck.org/article/2011/11/20/the-other-99-will-obama-betray-them/#commentsSun, 20 Nov 2011 20:09:13 +0000There is another 99 percent group in our country, distinct from but inextricably entwined with the now more familiar #99Percent. I refer to the 99 percent of American women who have ever had sexual intercourse and have used a birth control method at least some of the time.

There is another 99 percent group in our country, distinct from but inextricably entwined with the now more familiar #99Percent, those everyday Americans, who–in such a brilliant framing by the Occupy Wall Street movement–are to varying degrees affected by the vast economic inequality that characterizes American society. I refer to the 99 percent of American women who have ever had sexual intercourse and have used a birth control method at least some of the time. (As per the original Centers for Disease Control report, this statistic only includes contraceptive use reported by women during heterosexual intercourse).

Contraception obviously is a deeply held value by American women. But the fact that in the United States a startling half of all pregnancies are unintended makes clear that birth control is used only sporadically by some. There are a number of reasons why this is so, but a chief one is that so many women cannot afford contraception, especially the most expensive—and most effective–methods, such as birth control pills, and long lasting reversible contraception, for example, the newer (and far safer) models of IUDs (intrauterine devices). In short, the same economic disparities that pervade every other area of American life manifest here as well: poor women depend on publicly-funded programs for their contraceptive services, but, according to the Guttmacher Institute, only a little more than half of the 17 million women who need these services currently receive them.

This situation of tremendous inadequacy was supposed to improve considerably. In one of the best pieces of news in the otherwise embattled reproductive health world since the battles over health care reform began, the Obama administration announced last August that it would accept the recommendations of a special panel of the Institute of Medicine and include contraception—including all FDA-approved birth control methods—as part of the basic package of preventative health services that health insurance plans must offer, without co-payments.

Predictably, the August announcement has produced a massive campaign from opponents of contraception, especially the Catholic hierarchy. Though churches in fact have been granted an exemption from this requirement, the U.S. Conference of Catholic Bishops and its allies are pushing for much broader exemptions, for example to universities, social service agencies and other institutions with a religious affiliation—even if these institutions receive public funding. Such a move could potentially affect millions of women, of all religious backgrounds (or none), who work in such institutions.

My young friends who have been involved in the Occupy movement tell me that issues of reproductive justice have been muted, if evident at all, at the various Occupy sites. But as the occupiers put forward their vision of a just society, the old feminist dictum bears repeating: women cannot be full participants in any society unless they can control their fertility. The New York Timesquotes the president of the U.S. Conference of Catholic Bishops, reporting on a meeting with President Obama, as saying the latter “was very open to the sensitivities of the Catholic community.” President Obama, please be open as well to the tremendous struggles of women–members of both 99 Percent groups–who are desperate to control their childbearing in very harsh times.

]]>http://rhrealitycheck.org/article/2011/11/20/the-other-99-will-obama-betray-them/feed/5Did God Tell Congress to Wage War on Women?http://rhrealitycheck.org/article/2011/11/19/god-to-congress-wage-war-on-women/?utm_source=rss&utm_medium=rss&utm_campaign=god-to-congress-wage-war-on-women
http://rhrealitycheck.org/article/2011/11/19/god-to-congress-wage-war-on-women/#commentsSat, 19 Nov 2011 12:35:52 +0000God has apparently told members of Congress it is ok to wage war on women. Well, at least some Congressmen have decided this is the case.

Thanks to at least one member of Congress for setting us straight on that.

“It is not our job as Catholics to tell God what he should do. It is our job to learn and follow his teachings. Conscience is not convenience. We must enforce the laws of God.”

This was Rep. Tim Murphy (R-PA), who, having ascertained that the supreme deity is male, explained why Congress should deprive employees of Catholic schools, hospitals, and charities of the right to purchase affordable birth control, regardless of the employees’ own beliefs or practices. His statements were made at a hearing of the Health Subcommittee of the House Committee on Energy and Commerce on Wednesday, November 2, 2011.

Republicans in Congress are truly on the warpath against women’s rights, and in many cases against reason.

Just a few points here about women and contraception. For starters, while it usually takes two to conceive a child, only women get pregnant. The right and ability to make independent decisions about whether and when to become a parent are fundamental to every other aspect of a woman’s life: whether society recognizes women as autonomous, independent, responsible, and competent; and whether women themselves experience the same opportunities as men to acquire education and employment, and to construct a meaningful life based on loving relationships.

Cost is a barrier to purchasing birth control for lower-income women. More effective forms like new, safe intrauterine devices (IUDs) cost more than a year’s supply of birth control pills or devices like diaphragms which are cheaper overall but also are less reliable. The rate of unintended pregnancies is soaring among low-income women, and at 132 per thousand women ages 15 to 44 is five times higher than the rate for higher income women (those over 200 percent of poverty). Low income women are more likely to have unplanned births. The costs of contraception are minute compared to the costs of pregnancy and delivery, in dollars as well as in human health.

The new health reform law, the Affordable Care Act (ACA), calls for covering preventive health care services without requiring co-payments, effective in 2010. Co-payments are fees individuals must pay when they go for care, in addition to their premiums, and are intended to discourage health care visits. The problem is that they discourage people from getting care they need, particularly low-income people. Preventive health care services like flu shots can protect health by avoiding illnesses entirely or catching them early, and also save money. The ACA eliminated these co-payments for prevention.

Except in the case of contraception.

In 1968, despite the recommendation of the majority of Catholic bishops, the Pope adopted the minority recommendation to declare that using birth control was inconsistent with the Church’s beliefs. Nevertheless, U.S. Catholics continue to use birth control at the same rate as other Americans. Virtually all heterosexually active couples of child-bearing age in the United States use birth control. Still, the U.S. Conference of Catholic Bishops (USCCB) has grown increasingly insistent on enforcing the birth control ban.

As of August, 2011, after a year of studying whether or not contraception is a preventive health care service, and therefore should be covered without co-payments and deductibles, the federal Department of Health and Human Services (HHS) arrived at an answer: Yes on all counts.

In covering contraception as a preventive service without co-payments, HHS granted an exception for actual churches who provide health insurance to their employees, but required all other religiously-sponsored institutions such as hospitals that offer health benefits to follow the rule.

Catholic organizations have gone to court in the past to avoid state rules that require including coverage for birth control in the health care plans they provide for employees, and failed every time. The Church sponsors large organizations that include health care providers, universities and social service agencies, as well as churches. They employ millions of Americans, many of whom are not Catholic. Their work generates the funds their employers use to pay for health insurance. Most economists assert that the costs of employee health benefits are reflected in lower pay; that is, employers calculate benefits as a form of compensation, and many reduce wages accordingly. In effect, the money that pays for health insurance is really money that employees generate, and belongs to them.

This evidence is not good enough for the USCCB and the extremist Republicans running Congress. While dire economic threats face many Americans, Rep. Joe Pitts (R-PA), decided to change the subject. He called a hearing entitled “Do New Health Law Mandates Threaten Conscience Rights and Access to Care?”

Now let’s be very clear here. The Republicans and the Bishops are claiming that institutions have a conscience. Not a policy. A conscience.

Here is Joe Pitts’ description of his concern:

“Many entities feel that it [the proposed policy] is inadequate and violates their conscience rights by forcing them to provide coverage for services for which they have a moral or ethical objection. The religious employer exemption allowed under the preventive services rule — at the discretion of the HRSA [Health Resources Services Agency] — is very narrow.

“And the definition offers no conscience protection to individuals, schools, hospitals, or charities that hire or serve people of all faiths in their communities. It is ironic that the proponents of the health care law talked about the need to expand access to services but the administration issues rules that could force providers to stop seeing patients because to do so could violate the core tenants of their religion.”

In fact, there is no involvement of any individual employer in this matter, or any issue of an individual’s conscience except that of employees deciding to purchase and use contraceptives. The rule requires employers’ health plans to cover contraception without any additional co-payment. There are three parties involved here: employers, employees, and health plans. No provider or caregiver is involved, nor is any patient, student, or recipient of charity. At the most extreme, every Catholic institution could claim it will close their doors absent this exclusion. So far no such institution has done so where state requirements are in effect, and when Rep. Jan Schakowsky asked representatives of Catholic institutions at the hearing if they would close, they affirmed that they would not.

Rep. Gingrey (R-GA), opined: “Imposing the dictates of the state on the will of employers sounds un-American to me.”

And another gem: “Should we force religious employers to violate their consciences? To recognize same-sex marriage? Will we ethically neuter health care professionals?”

But Rep. Tim Murphy, a psychologist in his fifth term in the House, was on fire:

“Conscience is at the core of Catholic teachings… and it is not left up to individuals to decide, thank goodness. Father Anthony Fisher tells us that …there is an objective standard of moral conduct. Vatican II teaches us that the moral character of actions is determined by objective criteria, not merely by the sincerity of intentions or the goodness of motives. It is not, I repeat, it is not our duty as Catholics to tell God what he should do or what image he should adhere to, or what he should think, but it’s up to us to shape our conscience to conform with the teachings he’s given us.

“Conscience, sir,” Murphy continued, “is not convenience.”

“Conscience is formed through prayer, attention to the sacred and adherence to the teachings of the church, and the authority of Christ’s teachings in the church. So asking a group in a survey whether or not they have ever acted or thought of acting in a certain way that runs counter to the Church’s teachings is no more a moral code than asking people if they ever drove over the speed limit as a foundation for eliminating all traffic laws.

“I end with a quote from John Adams, in 1776,” said Murphy, “when he was writing our Declaration of Independence of the United States: ‘It is the duty of all men in society, publicly and at stated seasons, to worship the creator and preserver of the universe, and no subject shall be hurt, molested or constrained from worshipping God in the manner most agreeable to the dictates of his own conscience, or for religious profession or sentiments, provided he does not disturb the public peace or obstruct others in their religious worship.’ The foundation of our nation is not to impose laws that restrict a person’s ability to practice their faith, sir.”

]]>http://rhrealitycheck.org/article/2011/11/19/god-to-congress-wage-war-on-women/feed/1What Dr. Hathaway Told Mr. Pitts: Contraception is Necessary Preventive Carehttp://rhrealitycheck.org/article/2011/11/03/testimony-of-mark-hathaway-md-mph-director-of-obstetrics-and-gynecology-outreach-services-for-women/?utm_source=rss&utm_medium=rss&utm_campaign=testimony-of-mark-hathaway-md-mph-director-of-obstetrics-and-gynecology-outreach-services-for-women
http://rhrealitycheck.org/article/2011/11/03/testimony-of-mark-hathaway-md-mph-director-of-obstetrics-and-gynecology-outreach-services-for-women/#commentsThu, 03 Nov 2011 12:19:57 +0000There are those who assert that unintended pregnancy is not a health condition and therefore prevention of unintended pregnancy is not preventive health care. From my personal practice I can say that I cannot disagree more.

The following is the text of testimony given on November 2, 2011 by Dr. Mark Hathaway to the House Energy and Commerce Committee Hearing on conscience clauses and contraceptive coverage under health reform.

My name is Dr. Mark Hathaway and I am a board certified OB/Gyn. I am the director of OB/Gyn outreach services for Women’s and Infants’ Services at Washington Hospital Center. I am also the Title X Medical Director at Unity Health Care Inc., Washington D.C.’s largest federally-qualified health center system and the Title X grantee for the District.

I work in several medical facilities here in Washington, D.C. My patients tend to be women of color, primarily African American and Latina, and of lower socioeconomic status. Many of the patients I see are uninsured or underinsured and seeking family planning services. Despite their obstacles, they desire to improve their lives, and to have and raise healthy children.

I see every day how increasing women’s ability to plan their pregnancies makes a difference in their lives. And by the same token, I also see the negative consequences of unintended and unplanned pregnancy, late prenatal care, uncontrolled medical problems, poor nutrition, and sometimes depression. I see firsthand how cost can be a barrier when it comes to utilizing preventive care in general and using contraceptive services in particular.

That is why the IOM’s recommendation is so critically important. Contraceptive counseling and methods should be covered under the Affordable Care Act without cost-sharing. Any attempts to broaden exemptions to that coverage requirement would mean leaving in place insurmountable obstacles to contraceptive services for far too many women.

Cost is a barrier

I know from my day-to-day experiences what it means for patients who cannot afford to pay for their health services. The cost of a birth control method is frequently prohibitive for many of my patients. This is especially true for the more effective long-acting reversible contraceptive methods, aka LARC or “forgettable methods.” Women face many challenges in using contraception successfully. Too many women using methods like birth control pills, condoms and even injectables will experience an unplanned pregnancy during the first year of “typical use.” Indeed up to 50 percent of pill users will discontinue that method within the year, significantly increasing their chances of an unintended pregnancy.[1]

Long-acting reversible methods, including intrauterine contraceptives and implants, are the most cost-effective methods because they have an extremely low failure rate and are effective at preventing pregnancy for several years. However, the up-front costs of these methods can costs several hundred dollars, placing them out of the reach of millions of women who would otherwise use them.

Three recent studies have found that lack of insurance is significantly associated with reduced use of prescription contraceptives.[2] And several other studies have shown that when out-of-pocket costs are eliminated, women’s use of long-acting methods increases substantially. In St. Louis, researchers at Washington University have found that over 70 percent of women will choose a longer acting method if cost and barriers are eliminated.[3]

Preventing unintended pregnancy is critical preventive health care.

There are those who assert that unintended pregnancy is not a health condition and therefore prevention of unintended pregnancy is not preventive health care. From my personal practice I can say that I cannot disagree more.

Just last week I met “Sarah.” She’s 22, has two children under the age of three, one a newborn, and came in for a pregnancy test. Her diabetes had gone unchecked which would put her in a medically high-risk category for pregnancy. She was visibly shaking waiting for her pregnancy test results. She’s working over 40 hours a week at 2 jobs, and was told by her primary clinic that she would need to pay a copay of $40 and a $300 fee for the intrauterine device that she so desperately wants and needs. She would have been devastated by a positive pregnancy test.

She was incredibly relieved to learn she was not pregnant. Unfortunately she is uninsured but we used our rapidly shrinking safety-net resources to provide her with long acting contraception.

The evidence is also conclusive regarding pregnancy spacing. It is directly linked to improved maternal and child health, and to reduced infant mortality and maternal mortality rates. Numerous studies in the United States and internationally have found a direct causal relationship between birth intervals and low birth weight as well as preterm births. A 2008 literature review also shows that throughout the U.S. and Europe, there is an association between pregnancy intention and delayed initiation of prenatal care as well as reduced breastfeeding after a child is born. In other words, we need to help women plan their pregnancies for their health as well as their children’s.

Birth control is the most effective way to prevent unintended pregnancy

Using contraception is the most effective way to prevent unintended pregnancy — and ultimately to reduce the need for abortion. Again, I have seen the success of contraceptive services in my own practice, and again the evidence on this is clear. According to a recent Guttmacher Institute study, the two-thirds of women at risk of unintended pregnancy who use contraception correctly and consistently account for only 5 percent of the 3 million unintended pregnancies that occur each year. Put another way, 95 percent of all unintended pregnancies occur among women who use contraception inconsistently or use no method at all. Indeed, couples who do not practice contraception have an 85 percent chance of experiencing an unintended pregnancy within the next year.

Importance of the IOM Recommendation/Coverage

For all these reasons, the Institute of Medicine women’s health recommendations are groundbreaking. Finally, all women will gain access to insurance coverage of family planning services regardless of income. All women will be able to get the counseling, education, and access to the most effective and medically-appropriate contraceptive for them. This breakthrough has the potential to bring about major benefits for the health and well-being of women and their families. This comes from giving women the information and services necessary to enable them to plan and space their pregnancies.

Most women will contracept for approximately three decades during their reproductive years.The adoption of the IOM’s recommendations holds so much promise for millions of women who currently lack basic resources like health insurance coverage.

All of my training and experience tells me that what we are striving for is healthy women. We are also working to ensure that if and when they are ready to have a child that they have a healthy pregnancy to increase the chances of a healthy child. The best way to achieve this is to help women and couples become as healthy as possible before pregnancy. This includes financial health, emotional health, and physical health. We should trust women and empower women to make the appropriate decisions for themselves. Therefore, I hope we can at least agree that guaranteeing contraceptive coverage and removing cost barriers to being able to utilize contraceptive services should be at the forefront of preventive care so that women can achieve their own goals.

]]>http://rhrealitycheck.org/article/2011/11/03/testimony-of-mark-hathaway-md-mph-director-of-obstetrics-and-gynecology-outreach-services-for-women/feed/3Do New Health Law Mandates Threaten Conscience Rights and Access to Care?http://rhrealitycheck.org/article/2011/11/02/testimony-of-jon-o%E2%80%99brien-president-of-catholics-for-choice/?utm_source=rss&utm_medium=rss&utm_campaign=testimony-of-jon-o%25E2%2580%2599brien-president-of-catholics-for-choice
http://rhrealitycheck.org/article/2011/11/02/testimony-of-jon-o%E2%80%99brien-president-of-catholics-for-choice/#commentsWed, 02 Nov 2011 11:14:44 +0000I firmly believe the requirements under the Affordable Care Act, and the slate of regulations being created to implement it, infringe on no one’s conscience, demand no one change her or his religious beliefs, discriminate against no man or woman, put no additional economic burden on the poor, interfere with no one’s medical decisions, compromise no one’s health -- that is, if you consider the law without refusal clauses.

This testimony was submitted to the US House of Representatives Committee on Energy and Commerce’s Subcommittee on Health on November 2, 2011. It is written testimony for the hearing record on “Do New Health Law Mandates Threaten Conscience Rights and Access to Care?”

The article was amended at 12:38 p.m., Thursday, November 3rd to correct links in one paragraph.

Mr. Chairman, Ranking Member Pallone and Members of the Subcommittee, thank you for this opportunity to present testimony on behalf of Catholics for Choice on this important question of conscience rights and access to comprehensive healthcare.

For nearly 40 years, Catholics for Choice has served as a voice for Catholics who believe that the Catholic tradition supports a woman’s moral and legal right to follow her conscience on matters of sexuality and reproductive health. Throughout the world, we strive to be an expression of Catholicism as it is lived by ordinary people. We are part of the great majority of the faithful in the Catholic church who disagrees with the dictates of the Vatican on matters related to sex, marriage, family life and motherhood. We represent those who believe that Catholic teachings on conscience mean that every individual must follow his or her own conscience — and respect others’ right to do the same.

Certainly, at Catholics for Choice, we are no strangers to the intersection of religion, sex and politics. While religious voices and traditions are a vital part of public discourse, religious views should not be given disproportionate weight in public policy discussions. When this happens the lives of men and women can suffer greatly. We believe in a world where all voices, the voices of the religious and of the secular, of Catholics and non-Catholics alike, are heard in public policy discussions.

This hearing seeks to answer the question: Do new health law mandates threaten conscience rights and access to care? I firmly believe the requirements under the Affordable Care Act, and the slate of regulations being created to implement it, infringe on no one’s conscience, demand no one change her or his religious beliefs, discriminate against no man or woman, put no additional economic burden on the poor, interfere with no one’s medical decisions, compromise no one’s health — that is, if you consider the law without refusal clauses. When the question is asked in light of these unbalanced and ever-expanding clauses, the answer becomes yes, it would do all these things. When burdened by such refusal clauses, the new health law absolutely threatens the conscience rights of every patient seeking care for these restricted services and of every provider who wishes to provide comprehensive care to their patients. These restrictions go far beyond their intent of protecting conscience rights for all by eliminating access to essential healthcare for many, if not most patients, especially in the area of reproductive healthcare services. This will make it harder for many working Americans to get the healthcare they need at a cost they can afford.

The Affordable Care Act has many positive elements to it. Millions will now be able to access insurance coverage for their health needs and, with the basic level of coverage required under the new law, these newly insured and the millions of those better insured will now have greater access to a wider range of services than ever before. However, the law includes a refusal clause which has been expanded in the past decades to threaten the consciences of both those who seek to receive and those who want to provide services. Advocates of these expansive refusal clauses claim these are necessary to protect conscience rights. Others believe that refusal clauses such as these are simply part of attempts to derail the Affordable Care Act and to curb access to reproductive healthcare services entirely. Moreover, proposals to expand existing refusal clauses increase threats to the conscience rights of patients and providers by including not just abortion but also family planning services and, should some get their way, any other service deemed “unacceptable” by a tiny minority.

In recent years, under the guise of protecting religious freedom and “conscience rights” we have seen a dramatic upswing in attempts to expand the scope of refusal clauses, their application, and the entities able to utilize them. These new, ever-broader refusal clauses do far more than allow those healthcare professionals or social service providers with conscience objections to opt out. Instead, they are effectively being used as a means to refuse some treatments, medications, benefits and services to all comers.

These expansions have increased not only the services that may be refused—including reproductive health services as well as insurance coverage for those services and even training for medical professionals—but they have also the number of those who may claim these protections. Almost everyone, including most Catholics, agrees that it is reasonable to allow healthcare professionals, including doctors, nurses and pharmacists, to opt out of providing essential reproductive healthcare services and medications to which they conscientiously object. There is no doubt that there are times when the conscience of an individual doctor, nurse or pharmacist may conflict with the wishes orneeds of a patient. This often happens in cases related to abortion. Except in emergency situations, it is reasonable and indeed prudent to allow those who are opposed to abortion to opt out of providing the service. In these situations, women seeking these services should not have to worry about the religious and moral beliefs of their healthcare providers interfering with the provision of the best possible care. Therefore, it is in the best interests of all that only medical professionals committed to providing such services do so. Women need support and compassionate care when they access reproductive healthcare services, not judgment and disdain.

When this is not possible, a reasonable ethical fallback is for the institution to guarantee timely referrals to ensure that patients receive continuity of care without facing an undue burden, such as traveling long distances or encountering additional barriers to obtaining the desired services. Moreover, good practice should also compel a religious institution to make sure that the consciences of both the healthcare (or social services) provider and the patient (or client) are accommodated by having policies in place that enable individuals to receive whatever medications they are prescribed, procedures they require or services they seek.

Like many Catholics, I accept that conscience has a role to play in providing healthcare services, but recent moves to expand conscience protections beyond the simple right for individual healthcare providers to refuse to provide services to which they personally object go too far. Increasingly, demands and regulatory proposals attempt to grant that option to an institution or any individual along the spectrum of care, funding and coverage. It is incredible to suggest that a hospital or an insurance plan has a conscience. Granting institutions, or entities like these, legal protection for the rights of conscience that properly belongs to individuals is an affront to our ideals of conscience and religious freedom.

Allowing religious institutions to dictate the medical care available to their employees or religiouslyaffiliated organizations to dictate what services their beneficiaries are allowed to access would encroach on the individual consciences of those seeking care and assistance. Refusal clauses such as these fly in the face of true religious freedom by promoting the interests of certain elements of particular religions over the consciences and beliefs of individuals. They ignore the moral agency of the many who do not share the beliefs of a particular religious ideology. If allowed to stand, these refusal clauses do nothing but endanger many women’s access to the healthcare they need. When codified into law at the federal or state level, these “protections” actually constitute state-sponsored discrimination against women based on where they are employed, where and how they buy health insurance and where they seek to receive care.

Today, the 98 percent of sexually active Catholic women in the US who have used a form of contraception banned by the Vatican have exercised their religious freedom and followed their consciences in making the decision to use contraception. Thus, they are in line with the totality of Catholic teachings, if not with the views of the hierarchy. The problem is very clearly with the Catholic hierarchy and not the Catholic church, which includes the vast majority of the 68 million Catholics in the United States who use and support the availability of comprehensive reproductive healthcare services for all those who choose to utilize them.

Having failed to convince Catholics in the pews, the United States Conference of Catholic Bishops (USCCB) and other conservative Catholic organizations are now attempting to impose their personal beliefs on all people by seeking special protection for their “conscience rights.“ They claim to represent all Catholics when, in truth, theirs is the minority view. The bishops have identified several sympathetic high-profile allies in healthcare, education and social service provision to assist them in promoting their demands, but these allies are heavily reliant on the bishops for funding and prestige. Hospitals and colleges can lose their Catholic designation at the bishop’s whim, as happened recently in Phoenix, Arizona.

At a Catholic hospital in Phoenix, medical professionals acted to save the life of a pregnant woman by performing a life-saving abortion on a mother of four. The local bishop decided that his authority over the hospital allowed him to second-guess the medical decisions they made and he stripped the hospital of its Catholic designation. This is antithetical to the Catholic social justice tradition, which would not leave a woman’s life out of any healthcare equation.

What occurred in Phoenix helps to illustrate the problem with the bishops’ intrusion into medical decisions. The personal and professional freedom to make healthcare decisions is being threatened by expansive refusal clauses. The exemptions that the USCCB and other conservative Catholic organizations are demanding do not offer any more protection for religious freedom, but rather impede the religious freedom of millions of Americans, taking reproductive healthcare options away from everybody.

The USCCB and some Catholic organizations, many that receive taxpayer money, are asking to be allowed to:

deny condoms as part of HIV outreach;

ban employees and their dependents from getting the benefit of no-cost contraceptive coverage that other insured Americans enjoy;

opt out of providing emergency contraception to victims of sexual violence who come to Catholic hospitals for help; and

deny abortion care to everybody — even those women whose lives are threatened by their pregnancy.

They claim that they are representing all Catholics, but this is not true. The majority of Catholics support equal access to contraceptive services and oppose policies that impede upon that access.

Two-thirds of Catholics (65 percent) believe that clinics and hospitals that take taxpayer money should not be allowed to refuse to provide procedures or medications based on religious beliefs. A similar number, 63 percent, also believes that health insurance, whether private or government-run, should cover contraception. A strong majority (78 percent) of Catholic women prefer that their hospital offer emergency contraception for rape victims, while more than half (55 percent) want their hospital to provide it in broader circumstances. This support for the full range of contraceptive services is unsurprising, as restrictions such as refusal clauses or prohibitive costs affect Catholics just as often as non-Catholics — 98 percent of sexually active Catholic women have used a modern method of birth control,mirroring the rate of the population at large (99 percent).

Advocating for expansive refusal clauses in healthcare delivery regulations would affect all patients — whether those patients are Catholic or not. Seeking exemptions for religious organizations to cover essential health benefits, such as full coverage of recommended preventive services including contraception, under the Affordable Care Act will only serve to endanger many women’s access to the healthcare they need — whether those employees share those religious beliefs or not. In reality, these exemptions would deny the right of everyone seeking comprehensive healthcare.

When religious voices are allowed to direct policymaking, the best interests of those seeking healthcare services can be ignored. This is clear in the case of the Catholic healthcare industry which, despite providing much valuable service, persists in refusing to provide a full range of reproductive healthcare services, even to those who are in desperate need of them.

Respect for individual conscience is at the core of Catholic teaching. Catholicism also requires deference to the conscience of others in making one’s own decisions. Our faith compels us to listen to our own consciences in matters of moral decision-making and to respect the rights of others to do the same. Our intellectual tradition emphasizes that conscience can be guided, but not forced, in any direction. This deference for the primacy of conscience extends to all men and women and to their personal decisions about moral issues.

Our faith also compels us to respect religious pluralism and religious freedom. Religious freedom is an expansive rather than restrictive idea. It has two sides: freedom of religion and freedom from religion. It is not about telling people what they can and cannot believe or practice, but rather about respecting an individual’s right to follow his or her own conscience in religious beliefs and practices, as well as in moral decision making. The protections we put in place to preserve religious freedom do not permit religious institutions or individuals to obstruct or coerce the exercise of another’s conscience.

Sweeping refusal clauses and exemptions allow a few to dictate what services many others may access. They disrespect the individual capacities of women to act upon their individual conscience-based decision. They impede the rights of women and men to make their own decisions about what is best for their own health, and that of their families, as well as restricting their right to act upon those decisions without undue and unjust burdens.

One woman who saw these burdens placed on her conscience rights is “Sandra,” a science teacher at a Catholic school in the Midwest. Her story is an example of the many Americans who fall under these types of expansive refusal clauses being pushed by the bishops and their allied organizations. What is a reality for Sandra today is what many women can look forward to in their future.

As with almost all Catholic schools, Sandra’s employers follow diocesan rules regarding employees’ insurance — meaning no contraceptive coverage, regardless of medical necessity. When she first learned of the refusal clause proposed in the recent regulation to implement the preventive health services under the Affordable Care Act, she was outraged. As she explained to us, they added “insult to injury” by ignoring the healthcare needs of women like her and allowing her employers to continue to deny her coverage.

“I just never assumed that in 2011 I would be denied birth control,” she said. “I’m in my mid-twenties. I have no intention of having kids at the moment. I like teaching kids, but it’s a whole other thing having them.”

Sandra lost coverage when she began working under the jurisdiction of her local diocese. “I went to fill my birth control prescription like I always do. I say ‘Here’s my new insurance card,’ and they say I’m not covered,” she related. “They thought that it was weird and asked where I worked. As soon as I said I worked in a Catholic school, they said, ‘Oh, 99 percent of Catholic schools will not cover it. We’ve never had it covered before.’ I had no clue.”

For Sandra, this posed a significant hardship. She had taken a salary reduction in order “to go to work every day saying that it’s what I love.” She and her husband had carefully considered their insurance plans and determined that it was more economical for them to remain on separate policies, but once she had to pay out of pocket for the birth control that was best for her, a non-generic prescription, their careful financial planning was all for naught.

“Birth control is a lot of extra money on top of the salary reduction, but the principle of it is really what gets me,” she told us. “I don’t like being told by some guy that I’ve never met that I can’t use it. The bishops are not even having sex in the first place. How are they supposed to know how to tell me what to do in that situation?”

Her story, as she recognized, is all too common and reflects the repeated marginalization of many women by the Catholic hierarchy—the same women whose voices have been deemed unimportant by those on both sides of the recent debates. Sandra is just one of the many individuals whose conscience is not being protected by refusal clauses exempting entire institutions from covering their employees for services guaranteed to everyone else by the new law.

Catholic teachings on conscience require due deference to the conscience of others in making decisions — that the employer should not be allowed to dismiss the conscience of the employee seeking coverage for the healthcare services guaranteed to any other. In light of this precept, the public policy efforts of the hierarchy should take into account the experiences of individual Catholics as well as the beliefs of patients and clients, workers in social services and healthcare providers of other faiths and no faith, so that patients will not be refused any legal and medically appropriate treatment or be denied services they seek.

You have heard from some conservative Catholics on this issue, but it would be a grave mistake to confuse the individual positions of a few powerful interest groups with the majority view of the more than 68 million Catholics in the United States. For Catholic employers to claim to be the arbiter of any person’s good conscience is clearly disingenuous. When medical professionals refuse to provide legal reproductive health services, or provide timely referrals to other providers, they violate the right to conscience of the person seeking those services. This does not fall under anybody’s definition of a good conscience. Catholics for Choice and the majority of Catholics respect everybody’s individual conscience and their ability to act in accordance with their personal beliefs. However, we expect the hierarchy and their allied organizations, in keeping with the teachings of our shared Catholic faith and our American tradition, to respect our consciences and the consciences of the patients and clients who seek the services they need. We hope that those who serve to represent all of us in public service and in government will respect our consciences, too.

Protecting the freedom of conscience for all Americans no matter what their beliefs may be — for the atheist, for the employee of a Catholic institution, for the sexual assault victim who seeks care at a Catholic hospital — is indeed the job of the government. Expanding individual refusal clauses to include institutions and exemptions for religious institutions to deny the rights of all would sacrifice these people’s rights. Public policy should be implemented to further the common good and to enable people to exercise their conscience-based healthcare decisions.

Lawmakers of all political hues can come together to support a balanced approach to individual conscience rights and access to comprehensive healthcare. It makes sense for all those who want to provide more options to women seeking to decide when and whether to have a child. It makes sense for those who want to keep the government’s involvement in healthcare to a minimum. And it makes sense for those who think that it is the government’s role to facilitate the healthcare decisions that people want to make. Above all, it makes sense for a society that believes in freedom of religion — a right one can’t claim for oneself without extending it to one’s neighbor. The bottom line is that protecting conscience rights and preserving access to care shouldn’t just be about protecting those who seek to dictate what care is and is not available to all. Nor should it be for those who would dismiss the conscience of others by imposing their view of which consciences are worth protecting.

Protecting individual conscience and ensuring access to affordable, quality care is not just an ideal, it is a basic tenet of our society and it is the right thing to do. I thank the Subcommittee for inviting me today and for your attention. I look forward to any questions Members may have.

Nearly four in ten Latinos are uninsured. "Si se puede…" can mean "IF she can…" and this conditional statement hints at the obstacles that remain after the HHS decision. IF a Latina can get health insurance, IF she can make it to a provider's office who can provide culturally-competent care in her language, and IF she can obtain and fill her prescription, THEN she will be able to fully enjoy the benefits of no-copay birth control.

It’s about time we had some good news. It’s been a long, hot summer in DC and a rough year of partisan attacks on women’s health in Congress and around the country. Like a cool rain after a long drought, the Department of Health and Human Services (HHS) recommendations that birth control be covered without co-pay brought welcome relief to women around the country.

A refreshing example of sound policy informed by scientific and public health experts, this decision will have profound ramifications for many women and families, and may have special resonance for Latinas, immigrant women, and others who continue to face multiple barriers in accessing birth control. So, that’s the good news.

The not-so-good news? We’re going to need a lot more rain before this drought is over.

In honor of Latina Week of Action for Reproductive Justice 2011, I’m going to celebrate the HHS recommendations, while at the same time keeping in mind the unfinished work of ensuring access to contraception for all Latinas, including immigrant women.

It is not my intention to undersell the importance of the HHS decision. On the contrary, for too long, a woman’s ability to pay for birth control has determined whether and when she can prevent pregnancy, and including birth control as no-copay preventive care is a big step in the right direction.

And for Latino communities, economic relief of any kind cannot come soon enough. A new study by Pew shows Latino families have been hit hardest by the recession, accounting for the largest single decline in wealth of any ethnic and racial group in the country. These recent economic losses compound longstanding wealth and health disparities experienced by Latinas and their families. For Latinas who do have insurance or will be able to get it under the new exchanges, not having to pay out-of-pocket for their birth control could be transformative: leaving a little more money in the bank each month to help them with rent, tuition, buying groceries, and taking care of the children they already have.

But—and this is a big but—nearly four in ten Latinos is uninsured. And it probably comes as no surprise that lack of insurance is just one of many roadblocks Latinas encounter when they need to access health care, including contraception.

The Spanish phrase “!Si, se puede!” has long been used by Latinos the world over as a political rallying cry—and the two very different meanings of this iconic phrase may be instructive in examining the complex picture of Latinas’ access to reproductive health care. On the one hand, “Si se puede!” means “Yes we can!” an appropriate statement of celebration in the wake of this recent victory. (As in, “Thanks, Secretary Sebelius! Si se puede!!”) On the other hand, “Si se puede…” can also mean “IF she can…” and this conditional statement hints at the obstacles that remain. IF a Latina can get health insurance, IF she can make it to a provider’s office who can provide culturally-competent care in her language, and IF she can obtain and fill her prescription, THEN she will be able to fully enjoy the benefits of no-copay birth control.

For some women, that’s a few too many “ifs.” In addition to being less likely to have insurance, some Latinas, particularly immigrant or Spanish-dominant women, do not know where or how to find safe and accessible reproductive health care in their communities. Immigrant Latinas may be particularly vulnerable to unscrupulous “providers” who offer substandard care or misinformation. Just last week, reports surfaced that a counterfeit emergency contraception (EC) pill had been targeted to Latinas in the US. Other women may be experiencing contraceptive coercion, a form of intimate partner violence where a partner restricts a woman’s access to her birth control pills or refuses to use condoms. So even in a world where birth control is covered and hundreds of Planned Parenthood and other health clinics do provide quality care, some women could still slip through the cracks.

How can we reach the women who may not reap the benefits of the no-copay birth control decision? We can start by giving them more highly-effective options that do not require a provider’s supervision. Removing the age restriction on Plan B® emergency contraception would be a great start, and bringing a daily birth control pill over-the-counter also shows promise. If a woman of any age (or her partner, for that matter!) can pick up her EC or monthly pill pack with the rest of the shopping, more women will have birth control when they need it. (Intrigued? To weigh in with your thoughts on an over-the-counter birth control pill, you can fill out this survey.)

Every woman also needs better education about the full range of birth control options available to her. When unplanned pregnancy does occur, women need access to a full range of services: abortion care, prenatal care, and adoption counseling. Finally, reproductive health care does not exist in a vacuum: women also need social, educational, and economic opportunities, freedom from violence and coercion, and resources to care for their children and loved ones.

For many Latinas, the world I’ve just envisioned is still a long way off.

Our vigilance is needed to make sure that we build on all our victories by continuing to fight for more and better options for women. Just as every woman has different life circumstances that help determine what kind of birth control is right for her, each woman faces different barriers to accessing that birth control—including the need for insurance coverage and many others as well. We need more policymakers to take a cue from HHS Secretary Sebelius, and help create a world where every Latina “se puede,” where every woman has the support, education, and options she needs to plan pregnancy, care for her family, and care for herself.